Pituitary Adenomas: Surgery Perspective

  • William T. Couldwell
  • Martin H. Weiss


The first recorded attempt at surgical resection of a pituitary tumor was a two-stage lateral subtemporal decompression in an acromegalic patient performed by Caton and Paul [1]. They used a temporal approach as suggested by Sir Victor Horsley, who later used both a subfrontal approach and a lateral middle fossa approach in operating on 10 pituitary tumors [2]. The first successful removal of a pituitary tumor via a superior nasal transsphenoidal approach was in 1907 (Fig. 27-1) [3]–[5].
Figure 27-1

Schloffer’s transnasal transsphenoidal operation. (A) Incision made along the left nasolabial furrow around the left ala nasi and continued up to the glabella. (B) The incision cuts through the skin, nasal bone, philtrum, and the anterior part of the septum. The whole external nose is reflected to the right exposing the remainder of the septum. (C) The rest of the nasal septum has been removed exposing the rostrum of the sphenoid sinus. (D) The anterior wall of the sphenoid sinus is opened, the mucosal lining of the sinus is removed with a sharp spoon, and the floor of the sella is removed with a small chisel or punch forceps. (From: Cope VZ. The pituitary fossa and the methods of surgical approach thereto. Br J Surg 1916; 4:107–144. Used with permission.)


Pituitary Adenoma Pituitary Tumor Cavernous Sinus Sphenoid Sinus Gamma Knife Radiosurgery 
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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • William T. Couldwell
    • 1
  • Martin H. Weiss
    • 2
    • 3
  1. 1.Department of NeurosurgeryUniversity of UtahSalt Lake CityUSA
  2. 2.Department of Neurological SurgeryUSCUSA
  3. 3.Department of NeurosurgeryUSC University HospitalLos AngelesUSA

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